Download Ethical Problem Solving

Ethics: Making
Critical
Decisions in
Treatment
Patricia Sherman, Ph.D., LCSW
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An 18-year old adolescent who is 4 months
pregnant has contacted you several times in regard
to planning for her child. In her last visit, she
confided to you that she is habituated to heroin.
You have expressed your concern that the drug
may damage her unborn child, but she does not
seem worried nor does she want to give up use of
the drug. You also know that she obtains money for
heroin through prostitution and is not attending
school.
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You are an agency social worker whose Cuban client
has just told you she is HIV positive. She is in a
monogamous relationship and has two young
children. She does not plan to tell her partner about
her HIV status, fearing that this knowledge would
cause the relationship to break up. She says she
and her partner do not utilize safer sex practices and
that she could never ask him to use a condom, as
that would hurt his pride and cause him to become
suspicious.
Purposes of the NASW
Code of Ethics (Stone, 2004)
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Identifies core values on which social work’s
mission is based
Summarizes broad ethical principles that reflect the
profession’s core values and establishes ethical
standards to guide social work practice
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Is designed to help social workers identify relevant
considerations when professional obligations
conflict or ethical uncertainties arise
Provides ethical standards to which the general
public can hold the social work profession
accountable
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Socializes practitioners new to the field to social
work’s mission, values, ethical principles, and
ethical standards
Articulates standards that the social work profession
itself can use to assess whether social workers
have engaged in unethical conduct
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Provides practitioners with guidance when faced by
practice dilemmas that include ethical issues
Protects the public from charlatans and incompetent
practitioners
Protects the profession from governmental control;
self-regulation is preferable to state regulation
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Enables professional colleagues to live in harmony
with each other by preventing the self-destruction
that results from internal bickering
Protects professionals from litigation; practitioners
who follow the Code are offered some protection in
suits for malpractice
Social work
Ethical Principles
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Primary goal is to help people in need and to
address social problems
Challenge social injustice
Respect the inherent dignity and worth of the
person
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Recognize the central importance of human
relationships
Behave in a trustworthy manner
Practice within areas of competence and develop
and enhance professional expertise
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Acceptance
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Individualization
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Purposeful expression of feelings
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Nonjudgmental attitudes
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Objectivity
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Controlled emotional involvement
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Self-determination
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Access to resources
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Confidentiality and accountability
Begin With Values
Societal Values –
Professional Values –
Client Values –
Personal Values –
Values
VALUE is the reality in the inner core of a person
which:
 shapes one’s ideas
 conditions one’s feelings
 affects one’s behavior (Simon, Values Clarification,
1970, p. 25)
Whether recognized or unrecognized, values are
essential to professional action and to any
conception of practice theory
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Are implicit and explicit about what we cherish as
ideal and preferable
Determine which goals and actions we evaluate as
“good”
Shape our beliefs and our attitudes and, in turn, our
beliefs and attitudes shape our values

Define norms or guidelines for behavior
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Laden with emotions
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Influence our evaluations of situations and motivate
the actions we take
SOCIETAL VALUES
Social Justice Values
(Catechism of the catholic church, 1994,
catholic conference of the
united states bishops, 1995, himchak, 2007)
•Life
and dignity of the human person
•Call
to family
•Community
and participation
•
•
Rights and responsibilities
Option for the poor, the vulnerable, and people at
risk
•
Dignity of work and the rights of workers
•
Solidarity and care for God’s creation
Values shared by all
helping professions
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Autonomy
Nonmaleficence – do no harm
Beneficence – promote good
Justice
Fidelity – create trusting relationship
Veracity – be truthful
Common Social Work
Values
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Promotion of the client ‘s well-being and individual
dignity
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Self-determination
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The right to have basic needs met
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The right to actualize one’s full potential
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Client empowerment
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Human diversity
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Social and economic justice
Values specific to
work area
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Child welfare
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Protection of children
Preservation of families
Respect for families
Diligence – “hanging in there” with difficult situations
culture

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When do cultural/religious values of clients create
ethical concerns?
When do cultural/religious values of social workers
create ethical concerns?
Personal values
exercises
Scale of social distance

What’s your first response?
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On what are you basing your response?

What values does your response reflect?
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What feelings do you have about your response?
Cognitive dissonance
(Taylor, 2007)
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Feeling of discomfort arising from the conflict between
professional and/or personal values and job tasks
Social workers have to make decisions that both protect
society and maximize the rights of the individual
Strongest when a cognition related to self-concept conflicts
with a cognition about behavior
Potential problem
areas (IFSW, IASSW)
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Social worker’s loyalty often in the middle of
conflicting interests
Social workers function as both helpers and
controllers
Conflicts between duty to protect clients’ interests
and societal demands for efficiency and utility
Limited resources
SOCIAL WORKER’S ETHICAL
RESPONSIBILITY TO SOCIETY
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The social worker should promote the general welfare of
society
The social worker should act to ensure that all person have
access to the resources, services, and opportunities which
they require
The social worker should advocate changes in policy and
legislation to improve social conditions and to promote
social justice
Moral questions for
the Profession
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What are the clients’ rights as individuals?

What are their obligations to their families?
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Under what circumstances is it permissible to support the
breaking up of a family?
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Under what circumstances is it legitimate to
override client self-determination (e.g., clients with
mental illness who will not take medication)?
Is coercion justified in any given case? How far and
when is individual dependency a public
responsibility; how far and when a private
responsibility?
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In what circumstances, if any, should the client’s
confidence be violated by the social worker?
Should the social worker ever be responsible for
law enforcement?
ETHICS
The study of rightness and wrongness
of human conduct (Varga, 1980, p. ix).
It is that part of a moral philosophy that
concerns relationships between people, and
a set of values, assumptions, beliefs, and
normative rules that identify, support, and
explain the duties and obligations for good,
right conduct (Siporin, 1982. p. 523).
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Relates to what people consider correct or right
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Generates standards that direct conduct
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Represents “values in action”
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Social work ethics represents behavioral
expectations or preferences that are associated with
social work responsibility
Ethics and values
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Ethics are deduced from values and must be in
consonance with them
The difference between them is that values are
concerned with what is good and desirable while
ethics deal with what is right and correct. (Loewenberg
et al, 2000)
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Values deal with what beliefs are appropriate
Ethics address what to do with or how to apply
those beliefs
Ethical Standards
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Ethical Responsibilities to Clients
Ethical Responsibilities to Colleagues
Ethical Responsibilities in Practice Settings
Ethical Responsibilities as Professionals
Ethical Responsibilities to the Profession
Ethical Responsibilities to Society at Large
PROFESSIONAL ETHICS
Refers to the moral philosophy that is the
set of values, beliefs, and normative rules
that prescribes and explains the
obligations for good, right conduct on the
part of a profession’s members
Ethical Theory
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Deontological theories – certain actions are
inherently right or wrong, or good and bad, without
regard for their consequences. Rules, rights, and
principles are sacred and inviolable. The ends do
not necessarily justify the means
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Teleological Theories – the rightness of any action
is determined by the goodness of its consequences
Egoism – people should maximize their own
good and enhance their self-interest
 Utilitarianism – an action is right if it promotes the
maximum good
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Act utilitarianism – the rightness of an action is
determined by the goodness of the consequences
produced in that individual case or by that particular
act
Rule utilitarianism – takes into account the longterm consequences likely to result if one
generalizes from the case at hand or treats it as a
precedent
Kohlberg moral
dilemma exercise
KANT proposed that an action is good in itself not
because of the results it produced, but if it is the
product of good will. Kant’s theory is what is
sometimes called a universalistic or conservative
theory in that there are general rules that are not to
be broken in any situation
MORAL POSITIVISM states that morality is not
determined by the nature of an act but by extrinsic
factors. Morality is made and not discovered. The
fact that something is prescribed or forbidden
makes it good or bad (Hammurabi Code, Ten
Commandments)
THOMISM is an ethical theory that is very influential in
current thinking about ethics in medicine.
According to Aquinas, ”The perfecting of creatures
through the development of their natures constitutes
the highest good for them”
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The first natural law is that all actions that conserve
life or avoid death are included in moral law
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Since all living creatures share a natural inclination
to propagate the species, a natural law for mankind
is that the species should be propagated and
children educated
Human beings are rational beings and should
therefore seek truth and avoid ignorance
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Aquinas did not believe that actions contrary to
moral law are wrong simply because they are
prohibited by God; rather, he believed that they are
prohibited by God because they are wrong
God-given law - Life is sacred
Confidentiality and
Privileged
Communication
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Confidential information includes personal details
about the client’s identity, records of verbal
statements made by the client, professional reports
or professed opinions concerning the client, and
content from other records (Reamer, 1995)
Relative Confidentiality is a broad term that exists for
the protection of the individual client but may allow
a limited amount of disclosure, especially to those
co-workers, superiors, and subordinates whose
knowledge of certain communications is required to
aid in the therapy or planned change process of the
client
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Privilege refers to legal rights transpired between
the worker and client and is protected by law and
cannot be revealed without that client’s expressed
permission (Barker 1999)
Relative confidentiality is much more common than
privilege
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Social Workers may disclose confidential
information when appropriate with valid consent
from a client or a person legally authorized to
consent on behalf of a client or when needed to
defend self (NASW 1996)
Should inform the client to extent possible about the
disclosure of confidential information and the
potential consequences when feasible before the
disclosure is made
Self-Determination
and Paternalism
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Self-determination is an ethical principle that
acknowledges people’s right to make their own
decisions and choices (Barker 1999)
Paternalism is action that interferes with a client’s
wishes or freedom for his own good (Reamer 1995)
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Evaluate client’s decision-making capacity. In the
social worker’s professional judgment, clients’
actions or potential actions pose a serious,
foreseeable, and imminent risk to themselves or
others
It also urges action on behalf of clients and pursuit
of courses of action that safeguard such clients
Dual Relationships
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Dual Relationships are those where social workers
engage in more than one relationship with a client,
becoming social worker and friend, employer,
teacher, business associate, or sex partner (Kagle
1994)
Social worker assumes more than one role
concurrently or consecutively
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Social Workers should not engage in dual or
multiple relationships with clients or former clients in
which there is a risk of exploitation or potential harm
to the client (NASW CODE)
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Involves boundary issues
Boundaries are invisible barriers that separate
various roles and limit the types of interaction
expected and considered ethically appropriate for
each role
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Example: Social worker and client attend the
same AA meeting
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Think about boundary issues and establish
professional boundaries from the beginning, taking
cultural issues into consideration
Consult your supervisor and professional
colleagues
Scrutinize your own motivations
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Discuss with the clients
Sexual attraction – refer client to another
professional if this cannot be resolved through
supervision; never act on it
Distribute fliers on client rights and professional
ethics
Whistle-Blowing
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Act of informing on another or making public an
individual’s, group’s or organization’s corrupt,
wrong, illegal, wasteful, or dangerous behavior
How great is the threat to the potential victims?
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What type and quality of proof are available that the
wrongdoing has occurred or is going on?
Are there less severe alternative measures you
might take to remedy the problem?
Can you assume the burden of risk? How much do
you have to lose?
Guidelines for Ethical
Decision Making (Reamer, 1999)
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Rules against basic harms to the necessary
preconditions of human action (such as life itself,
health, food, shelter, mental equilibrium) take
precedence over rules against harms such as lying
or revealing confidential information or threats to
additive goods such as recreation, education, and
wealth
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An individual’s right to basic well-being (including
goods that are essential for human action) takes
precedence over another individual’s right to selfdetermination
An individual’s right to self-determination takes
precedence over his or her right to basic well-being
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The obligation to obey laws, rules, and regulations
to which one has voluntarily and freely consented
ordinarily overrides one’s right to engage voluntarily
and freely in a manner that conflicts with these
laws, rules, and regulations
Individuals’ rights to well-being may override laws,
rules, regulations, and arrangements of voluntary
associations in cases of conflict
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The obligation to prevent basic harms
such as starvation and to promote public
goods such as housing, education, and
public assistance overrides the right to
complete control over one’s property
Process of Ethical
Decision Making
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Identify the ethical issues, including the social work
values and duties that conflict
Identify the individuals, groups, and organizations
likely to be affected by the ethical decision
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Determine what additional information you need
and how that information might affect your decision
Tentatively identify all viable courses of action and
the participants involved in each, along with the
potential benefits and risks for each
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Thoroughly examine the reasons in favor of and
opposed to each course of action, considering
relevant
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Ethical theories, principles, and guidelines
Codes of ethics and legal principles
Social work practice theory and principles
Client’s values (including religious, cultural and ethnic
values, and political ideology), particularly those that
conflict with one’s own
Personal values
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Consult with colleagues and appropriate experts
(such as agency staff, supervisors, agency
administrators, attorneys, ethics scholars)
Make the decision and document the decisionmaking process
Monitor, evaluate, and document the decision’s
outcome
Ethics Audit
(Reamer, 2000)
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Client rights
Confidentiality and privacy
Informed consent
Service delivery – competence
Boundary issues and conflicts of interest
Documentation
Defamation of character
An ethics audit should assess social
workers’ familiarity with the variety of
ethical dilemmas germane to their
practice setting and the procedures
they use to make ethical decisions
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Supervision and training
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Consultation
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Referral
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Fraud
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Termination of services
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Practitioner impairment
Discussion of
Specific
Ethical
Dilemmas